Introduction

Congenital heart defects are seen in babies and children since birth. While these defects have been there since the evolution of man, their detection and treatment due to improvement in medical care and technology has been a relatively recent phenomenon – a little more since 50 years or so.

India has been a late starter in this sphere compared to other western countries due to other health care priorities, but has caught up quickly in the last two decades in the capabilities to provide excellence in care for children with heart ailments.

Certain changes in India have caused congenital heart problems to assume significance. Nuclear families, smaller families where each child is a valued member, improved earnings of young parents, advances in non-invasive diagnostic modalities like echocardiography, availability of surgical skills and infrastructure with better ICU care and more successful results, and gradual reduction of infant mortality due to infectious diseases, have all contributed to congenital heart defects becoming an important issue in children. Also the fact, that early timely treatment could assure a near normal quality of life to these kids to the joy of parents has also contributed to its growth.

Early detection and treatment aided by advanced technology has significantly improved the survival and quality of life of newborns. The Children's Heart Centre at Kokilaben Hospital, Mumbai, is a world-class facility specialising in providing comprehensive care for:

Neonates, infants and children with all types of heart ailments, and

Adults with simple and complex CHD

Problem in India

India has a large population. With a perceived incidence of congenital heart disease in 8 per 1000 live births in children, nearly 180,000 kids are born yearly with this problem. Of these 60,000 to 90,0000 are critical and need early treatment. Nearly 10% of the infant mortality seen is due to congenital heart defects. As the number of centres capable of handling this is very few, a huge number of children are added to this pool each year with many of them, who might have lived a near normal life, dying, due to unavailability of treatment to them. This, coupled with economic constraints, leaves only a small fraction that has access for appropriate treatment.

constraints, leaves only a small fraction that has access to appropriate treatment.Congenital heart disease treatment needs a full time and dedicated team of professionals with full time paediatric cardiac surgeons, paediatric cardiologists, anaesthesiologists, intensive care specialists, perfusionists, nurses and other paramedical staff. In essence, it needs a dedicated institutional practice which has not been seen in this part of the country till recently.

Kokilaben Hospital is aiming to usher in a new pattern of medical care – that of a full time institute of excellence to treat congenital heart disease and bridge this long-felt lacuna seen in Mumbai since 2009.

Scenario In Mumbai

Mumbai has been a leader in many fields of medical care and has some of the finest centres of medical excellence. However, in the field of congenital heart care it has hopelessly lagged behind when compared to South India or Delhi. A whole lot of children from Mumbai have had to go to centres located outside for treatment much to the inconvenience of the families. This has been solely to the type and culture of medical practice prevalent here – which favours individuals operating in many hospitals, than a team in one place.

Congenital heart disease treatment needs a full time and dedicated team of professionals with full time Paediatric Cardiac Surgeons, Paediatric Cardiologists, Anaesthesiologists, Intensive Care Specialists, Perfusionists, Nurses and other paramedical staff. In essence, it needs a dedicated institutional practice which has not been seen in this part of the country till now.

Kokilaben Hospital is aiming to usher in a new pattern of medical care – that of a full time institute of excellence to treat congenital heart disease and bridge this long-felt lacuna seen in Mumbai.

Why the Children's Heart Centre at Kokilaben Hospital?

The Children's Heart Centre at Kokilaben Hospital, Mumbai, is a world-class facility specialising in providing comprehensive care for neonates, infants and children with all varieties of heart ailments, and adults with simple and complex congenital heart defects.

The centre is manned by a very experienced and accomplished team of professionals drawn from the best available talent in the country. Being an institute and a centre of excellence, our doctors are attached to the hospital whole time, and are available to our patients round the clock. This has helped in ensuring close monitoring and excellence in delivery of care to very critical children, after cardiological interventions, or complex open heart surgery leading to success rates matching the best centres of the land and overseas.

The centre aims to be a nodal tertiary referral centre for heart-related problems in children, along with strong academic and research programs.

Division of Paediatric Cardiology

The division of Paediatric Cardiology has full time dedicated and exclusive Paediatric Cardiologists with a wide ranging experience in delivering holistic care to a child with cardiac problems. The specialists have expertise in all forms of cardiological evaluations and interventions to benefit children with cardiac ailments ranging from neonates to adults with congenital heart defects.

As echocardiography forms a very important method of evaluation of a patient with cardiac issues, the division is equipped with the latest equipments capable of performing all forms of echocardiography including 3D evaluation and transesophageal echocardiography in babies. Other non-invasive methods of evaluation such as CT / MRI are also available in house. In addition, facilities for prenatal detection (Fetal echocardiography) of congenital heart defects are available along with management of high risk pregnancies.

A dedicated catheter laboratory for children has been provided where any kind of diagnostic or therapeutic intervention or procedure can be performed on patients of all ages. Interventions such as device closure of PDA, ASD, VSD and all varieties of interventions across all ages like balloon valvotomies, coarctaion dilatation and stenting, balloon arterioplasties and stenting, balloon atrial septostomies and so on are routinely performed with results matching the best global centres.

In addition, the division also undertakes to perform remote non-invasive cardiac evaluation of children with cardiac problems and arrange transport to the facility at KH. The paediatric cardiology division is ably supported by other in house paediatric sub-specialities, including a superbly-equipped neonatal intensive care unit.

Division of Paediatric and Congenital Heart Surgery

The division of paediatric and congenital heart surgery is manned by a team of full time dedicated and exclusive paediatric cardiac surgeons with a blend of youth and experience. The surgeons are full time attached to Kokilaben Hospital and are available to our patients round the clock. They are specially trained to undertake all kinds of simple or complex, closed or open heart surgeries, for correction of congenital and acquired heart defects in neonates, infants, children and young adults. However, any adult with congenital heart defects are also deftly handled by this team.

All varieties of closed heart surgery such as Pulmonary Artery Banding, PDA interruptions, coarctation repairs, Shunts, Pacemaker Implantations and so on, are performed on a regular basis. Complex major open heart surgeries in neonates such as arterial switch operations, aortic arch interruption or coarctation corrections with VSD closure, Obstructed Total Anomalous Pulmonary Venous connections, TruncusArteriosus and Norwood operations, other operations such as correction of complete Atrioventricular Canals, Tetralogy of Fallot, Double Outlet Ventricles, Senning operation, Closure of all kinds of VSD / ASD, double switch operation, Glenn shunts and Fontan operations in infants, children and adults are routinely done with results matching international centres.

All varieties of closed heart surgery such as

Pulmonary artery Banding

PDA interruptions

Coarctation repairs

Shunts

Pacemaker Implantations

and so on, are performed on a regular basis.

Complex major open heart surgeries in neonates such as

Arterial switch operations

Aortic arch and left ventricular outflow tract repairs

Coarctation corrections with VSD closure

Obstructed Total Anomalous Pulmonary Venous connections

Truncus Arteriosus

Norwood operations

Root translocations

Other operations, such as

Correction of complete Atrioventricular Canals

Tetralogy of Fallot

Double Outlet Ventricles

Senning operation

Closure of all kinds of VSD / ASD

Double switch operations

Glenn shunts and

Fontan operations

In infants, children and adults are routinely done with results matching international centres.

Incisions through right chest and giving a more cosmetic incision are also carried out frequently. More than 3500 children have had successful open heart surgery since 2009.

Division of Paediatric Cardiac Anaesthesiology and Intensive Care

The Division of Paediatric Cardiac Anaesthesiology and Intensive Care has full-time, dedicated and highly skilled clinicians. Our team includes anaesthesiologists, intensivists, paediatricians and trainee fellows.

The anaesthesia team is highly proficient to conduct anaesthesia in a wide range of patients ranging from few hours old babies, weighing 500 grams to obese grown up children. Our operation theatre is equipped with laminar flow, state-of-the-art anaesthesia workstation and dedicated Paediatric Transesophageal Echocardiographic (TEE) probe. We ensure that most patients undergo TEE or Epicardial Echocardiography before and after surgery to ensure optimal outcome. There are two dedicated operating rooms for children with cardiac lesions.

Our PCICU plays a pivotal role within the Children's Heart Centre of Kokilaben Hospital. A team of experienced anaesthesiologists, paediatric intensivists, neonatologists and nurses are dedicated to the collaborative management of patients in the PCICU. Our intensivists work full-time in the PCICU and their knowledge, together with sophisticated monitoring and latest equipments, enables them to recognise problems quickly and respond effectively.

State-of-the-art equipment like HFOV (High Frequency Oscillatory Ventilation), Nitric Oxide and facilitates to institute ECMO (Extra Corporeal membrane Oxygenation) in the ICU are available. NIRS (Near infrared Spectroscopy) in another monitoring that is available now matching international standards of care.

This is done in a most uncompromising manner with periodic reviews and updates of all our practices and procedures.

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